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The Dangerous Superbugs Hiding in Your Dinner

Farms helped create lethal, drug-resistant bacteria. Government has ignored the problem. And now almost anything you put in your grocery cart—meat, poultry, seafood or produce—could be contaminated. SELF investigates.

Lisa Bonchek Adams didn't think anything could make her sicker than the hell she went through five years ago—a double mastectomy, chemo and the removal of her ovaries. Then she sat down to a meal with a girlfriend in June 2010 and ordered a grilled-chicken salad.

The next afternoon, she was struck with intense nausea and her stomach started rumbling. "Uncontrollable diarrhea," the 42-year-old recalls with a wince. She tried to wait it out, but 24 hours later, she was seeing blood in her stool. So she begged her doctor to see her on a busy Friday. She gave her an antibiotic and urged her to head straight to the emergency room for IV fluids.

A few days later, test results revealed she had campylobacter, an infection that undercooked chicken can transmit. The doctor gave Adams a second antibiotic, Cipro, which normally knocks out the germ. She took it for 10 days and felt slightly better. Still, the mere thought of eating made her feel faint. She sipped chicken broth, but anything more than a bite of bread roiled her stomach again. "Stick with it," she recalls the doctor telling her. "When an infection wipes out your intestines, it can take some time to reset."

But within days of finishing the drugs, Adams found her symptoms had returned in full force. She called her doctor's office immediately and learned the problem: The campylobacter strain, the doctor surmised, was resistant to both antibiotics she had been given. "I was miserable, and so scared for my health," she says.

As someone who blogs about cancer, Adams is medically sophisticated. But the possibility that foodborne illness could be resistant to antibiotics had never occurred to her. Nor could she have imagined the damage the bacteria could do. A third prescription killed the infection, but the aftermath stretched on. For four months, she could take in nothing but liquids and the simplest carbs. She was exhausted and couldn't exercise. When she ventured out to meet friends for dinner, the sight and smell of a steak turned her stomach and made her flee the restaurant. By the time she finally recovered, she had shed more than 20 pounds from her already slim frame. "People would say, 'What are you doing? Are you running?'" she says. "And I'd think, No, I'm dying."

We've grown depressingly accustomed to the possibility that our dinner might make us sick; 1 in 6 Americans suffer foodborne illness every year, estimates the Centers for Disease Control and Prevention (CDC) in Atlanta. Still, most of us think of it as a day or two of misery: We cope on our own if symptoms are mild and ask our doctors for antibiotics if they are severe.

As Adams found, however, the bacteria on and in our food—not only poultry, but also meat, eggs, shrimp and produce—are getting harder to knock out. New, drug-resistant varieties of campylobacter, salmonella, E. coli and staph have all emerged. For those of us unlucky enough to catch one of these superstrains, the arsenal of drugs that work is smaller than it is for weaker strains, and treatment becomes more complicated once the bacteria have taken hold. As a result, previously minor infections are putting Americans in the hospital—and, in rare cases, killing us.

Let's run through the stats: Earlier this year, the CDC was tracking an outbreak that sickened 20 people, mostly in New England, from drug-resistant salmonella linked to ground beef. Last year, 136 people in 34 states were made sick by resistant salmonella tied to ground turkey, and 12 people in 10 states were made ill by resistant salmonella associated with premade turkey burgers. A strain of drug-resistant E. coli on salad sprouts sickened nearly 3,900 people in Europe last summer, including six Americans, one of whom died. There were three known foodborne superbug outbreaks in 2009; two in 2007; and one in 2004—caused by shrimp contaminated with drug-resistant E. coli—that had 130 known victims. Although the link between farm-bred superbugs and stomach illness is most clear, researchers worry that food may be transmitting other illness as well, including drug-resistant infections of the skin, urinary tract and blood.

Foodborne superbugs may take victims by surprise, but according to researchers and advocates, there is no mystery about their origin. Hundreds of pieces of research since the 1970s show that a routine farming practice—inappropriately giving antibiotics to animals—has helped encourage antibiotic-resistant bacteria to grow and spread. Now, in unpredictable ways, those germs have moved into our environment, including the environment of farms that harvest vegetables.

Spokespeople for agriculture say that, although resistance may develop this way, misuse of antibiotics by doctors and patients plays a much larger role. "When you look at the majority of the resistance problems in human medicine, they involve pathogens that have little to anything to do with animals," says Richard Carnevale, V.M.D., vice president of regulatory, scientific and international affairs at the Animal Health Institute in Washington, D.C., which represents makers of veterinary medications, including antibiotics. "We look not at the possibility of resistance transfer from animals to humans, but the probability, which is quite low, based on the data we have seen."

Many major heal th organizations, including the American Medical Association, see it differently. "The science is indisputable at this point," says Robert Lawrence, M.D., Center for a Livable Future Professor at the Johns Hopkins Bloomberg School of Public Health. "Industry wants to lay all the blame for the emergence of antibiotic-resistant bacteria on the medical profession, but the epidemiologic evidence doesn't add up."

That evidence shows superbugs all over our food. Half of pork chops and 43 percent of ground beef and chicken breasts carry salmonella resistant to at least three families of antibiotics, according to government testing. Drug-resistant staph (including methicillin-resistant Staphylococcus aureus, aka MRSA) turned up in one out of four supermarket meat samples tested by an independent institute in Flagstaff, Arizona. Researchers have found drug-resistant E. coli on grocery store beef and pork as well as the virulent intestinal bacterium C. difficile on chicken.

"Imagine there was a terror ist organization that wanted to infect the American population, that built huge factories for creating literally trillions of drug-resistant bacteria, contaminated our food with them and distributed them to every grocery store," says Lance B. Price, Ph.D., director of the Center for Food Microbiology and Environmental Health in Flagstaff, who conducted the staph investigation. "Can you imagine the public response? And yet that is what the food-animal industry is doing to us every day."

The practice of giving antibiotics to farm animals dates back to the 1950s, when researchers discovered that mixing drug-manufacturing leftovers into livestock feed made animals process food more efficiently and thus pack on weight quickly. The practice boosted profits for both drugmakers and farmers, who could raise animals on less feed, sell them faster and pack them into cramped spaces, where germs would otherwise spread unchecked. Farmers soon discovered that drugs in feed would also act as a prophylaxis, protecting herds against illness and in theory keeping animal diseases out of food.

It took another decade for scientists to realize there might be a downside. A Food and Drug Administration report in 1972 suggested that antibiotic use for what's now known as "growth promotion"—making healthy animals fatter—was contributing to a rise in resistance.

The problem is that animals' guts, like ours, are full of bacteria. When the bugs reproduce, their genetic code accrues minor mutations, making some more resistant to the attack of antibiotics. And when an animal eats feed containing low doses of antibiotics, Dr. Lawrence explains, "susceptible bacteria are killed off, and the ecological niche that is vacated is filled with progressively more and more resistant bacteria."

There's another problem: Bacteria don't develop resistance only by mutation. They can also exchange genetic material with other bacteria in an animal's intestine, in manure or somewhere far from a farm. "So campylobacter that developed resistance in the gut of a broiler chicken may, out in the environment, exchange that small chunk of DNA with a salmonella," Dr. Lawrence says. "And then that salmonella causes a resistant infection in a human."

As early as 1977, the FDA proposed to withdraw its approvals for agricultural purposes of the main drugs in use at the time: penicillin and two forms of tetracycline. But agriculture and drug industry lobbyists pushed back, and 35 years later, a ban still hasn't happened. This April, the agency announced guidelines it hopes will phase out growth promotion in three years. But the rules are purely voluntary and allow for prophylactic use of antibiotics. That creates a big loophole: Farms might be able to keep using high levels of antibiotics in healthy animals, but now under the banner of "prevention" rather than growth promotion, says Laura Rogers, director of the Human Health and Industrial Farming Campaign, a project of the Pew Charitable Trusts, in Washington, D.C.

Cramming thousands of animals into close quarters, large-scale farms create an ideal breeding ground for bacteria.

Farmers use antibiotics to prevent, control and treat disease—and to fatten up their animals quickly.

The drugs kill off weak germs but leave the strongest, creating superstrains that circle back into the herd.

Resistant bugs travel out on farmers' hands, on the animals we eat and when manure gets into the air, water and soil.

The result is serious, lifethreatening infections of the gut—and perhaps the skin, bladder, blood and more.

Today, 80 percent of the antibiotics sold in the United States go to farm animals, not people, according to analysis by Rep. Louise Slaughter (D–N.Y.), the sponsor of a bill to ban growth promoters. They include the same medicine we take for stomach illness, pneumonia, skin lesions and more: not only penicillin and tetracycline, but also drugs similar to Bactrim and Keflex. And the majority of animals taking the drugs are not sick.

An animal that routinely ingests antibiotics on a farm becomes a "factory" for drug-resistant bacteria, as described by a 2011 article in Clinical Microbiology Reviews. Huge farms known as CAFOs, for concentrated animal-feeding operations, may house as many as 160,000 broiler chickens and 800,000 hogs, a 2008 survey by the Government Accountability Office found. These farms may pack animals like boxes in a warehouse: Hogs are kept in crates too small to turn around or lie down in, and laying hens are confined in cages the size of a sheet of paper. In badly run CAFOs, this overcrowding leads to filthy conditions that increase disease. When FDA inspectors examined Wright County Egg, an Iowa egg-production facility that likely contributed to almost 2,000 cases of salmonella in 2010, they found mice, flies, maggots and piles of manure up to 8 feet high.

Bacteria move off the farm in three ways, explains Ellen Silbergeld, Ph.D., professor of environmental health sciences at the Johns Hopkins Bloomberg School of Public Health. The first is in manure: Even on a well-run farm, thousands of pigs will produce a lot of it. Whether dumped into fetid lagoons or spread as fertilizer, manure contains resistant bacteria and undigested antibiotics that move into the environment on wind and water and linger. "Salmonella and some E. coli can survive in soil for months," says Michael Doyle, Ph.D., director of the Center for Food Safety at the University of Georgia in Griffin. Farmworkers may also bring the bacteria home and spread them to friends and family. And most important, animals pass us germs when we eat them and when meat contaminates kitchen and restaurant surfaces. "This carries risks to people all across the country, because our food supply is national," Silbergeld says.

Consider the salmonella outbreak caused last year by ground turkey; it lasted seven months and spread across two thirds of the nation. Nine-month-old Ruby Lee got sick after eating only a few morsels sautéed by her 24-year-old mother, Melissa Lee. "It was the first time she had eaten ground meat," Lee says. Soon Ruby was fussy, feverish and soiling 20 diapers a day with diarrhea.

Lee has never forgotten her dread when the doctor urged her to rush Ruby to a hospital 20 miles away in Portland, Oregon. "She said, 'We don't know what this is,'" Lee says. "That is not something you ever want to hear." Recovery would involve seven days in isolation, the first three spent trying to find the right dose of drugs to kill the infection, plus six days on an IV at home.

Ruby's ordeal was an illustration of the complexity of modern food distribution: Victims of an outbreak can be so dispersed that it takes months for officials to perceive and publicize the dangers. People began falling ill in March 2011, but federal and state health authorities did not make the connections until May. It would take another two months before investigators could prove that the likely cause of the illnesses was not only turkey, but a particular brand of turkey carrying a specific strain of salmonella that was resistant to multiple drugs.

In the first days of August—just as the government had finally sounded an alert and Cargill Meat Solutions had recalled 36 million pounds of ground turkey—Susanne Schwalbe Byerly, a 32-year-old administrative assistant, was on vacation in Tennessee with her family. They had rented a condo, stocked the kitchen and made spaghetti sauce with ground turkey, at her mother's request for something lowfat. Three nights later, Byerly woke up vomiting, achy and shaking with chills. "The fever lasted after the vacation ended," she says. "Every morning I woke up with headaches and sweats."

Her symptoms were so odd that her regular doctor suspected she had caught a tickborne illness while hiking and gave her two antibiotics. They made little difference. After the results of her blood tests came back, the doctor tracked her down with multiple, urgent phone calls: Byerly had signs of sepsis, a potentially fatal blood poisoning. She stayed in the hospital for two days and had already gone home when the county health department called to tell her she had been infected with the nationwide salmonella strain. While symptoms had dragged on, her bug had spiraled into sepsis. "I felt I had no control over what had happened to me," she says. "I am so lucky it didn't get worse."

Byerly is right: Without quick action, any infection can escalate, says Edward J. Septimus, M.D., an infectious-disease specialist at the Texas A & M Health Science Center. You don't have to be older, immune-compromised or an infant to be at risk. Even something as routine as an infection of E. coli can ascend from the bladder to the kidneys and into the bloodstream. "A young, healthy person can come in off the street with a bad kidney infection that leads to septic shock," Dr. Septimus says.

In the spring of 2010, Mae Gentry was taken by surprise by a bladder infection. "I have had maybe three UTIs in my entire life," says Gentry, a writer and actress in Los Angeles. She was even more surprised when the doctor's office called to change her prescription—the bacteria that had infected her was resistant and the meds her doctor had initially prescribed would have no effect on the pain and burning.

As it turns out, the type of E. coli Gentry contracted has been the focus for a decade of a group of scientists in several countries—and they suspect the germ can be spread by food. They have seen the same patterns of resistance in bacteria found on retail chicken and strains infecting people with UTIs. "I've found out this drug-resistant E. coli is on the rise all over the world," Gentry says. "I don't know what to do to prevent this from happening again."

Confronted with such a sweeping problem, what can consumers do? "The person who is preparing the food has the most ability to safeguard against foodborne illness," says Stuart Levy, M.D., professor of medicine and molecular biology and microbiology at the Tufts University School of Medicine. Smart food-safety precautions will protect against all bacteria, including resistant strains.

That can mean something as simple as washing your hands with warm water and soap before and after cooking and using a paper, not cloth, towel to absorb the bacteria that weren't washed away. "The one thing disease-causing bacteria are not resistant to is heat," Dr. Levy adds. Cooking ground meat throughout is especially crucial: Bacteria is mixed into the interior of a burger, even one made of turkey; with steak, germs stay on the outside.

Shoppers can support organic meat and produce farmers, who can be prosecuted for fraud if they use antibiotics. (Grass-fed, cageifree or natural products aren't drug-free by definition.) "If consumers indicate they don't want antibiotics being misused in animal husbandry, and are voting with their pocketbooks, that matters," says Margaret Hamburg, M.D., commissioner of the FDA. Still, growers of organic veggies aren't required to use manure from only organic herds. And organic meat is sometimes processed in the same slaughterhouses as conventional meat is. But organic farmers do work to mitigate the risk. "The bottom line is that organic meat products, by far, have lower levels of antibiotic-resistant bacteria," says Amy R. Sapkota, Ph.D., author of a study on the issue for the University of Maryland School of Public Health.

"The best thing we can do is to hold the FDA's feet to the fire to ensure that they meaningfully change the way industrial farms use antibiotics," says Rogers of the Pew Charitable Trusts. Pew has attracted nearly 23,000 people to join its Moms for Antibiotic Awareness Campaign at SaveAntibiotics.org, which is pressing to close loopholes in the recent FDA action.

Other advocates continue to want a ban on certain antibiotics in farming. In March, a judge ruled for advocacy groups that sued the FDA over its failure to ban penicillin and tetracycline, which continue to represent almost half of all drugs given to livestock. The agency, the judge said, must go ahead with the hearings that were never scheduled 35 years ago, and it must call on drug manufacturers to appear and prove that growth promoters are safe.

For Everly Macario, the debate is settled. A Chicago mom with a doctorate in public health, she watched her 17-month-old son, Simon, die only 24 hours after developing a resistant staph infection in 2004. Now a face of the Pew campaign, Macario is haunted by the idea that germs as uncontrollable as MRSA might lurk in our food. "If more women talk about it, people will wake up and recognize what this means," she says. "Antibiotic resistance is a huge problem, and it's getting worse. It might get to the point where our medicine just doesn't work."